CVS unit ordered to pay $95 million in Medicare whistleblower lawsuit
June 26 (Reuters) - CVS Health's (CVS.N), opens new tab pharmacy benefit manager unit must pay the U.S. government $95 million after a federal judge found it overcharged Medicare for prescription drugs.
Chief Judge Mitchell Goldberg in Philadelphia ordered the payment by CVS Caremark on Wednesday, following an eight-day non-jury trial in March in the whistleblower case.
Goldberg will decide after further briefing whether to triple the award to $285 million under the federal False Claims Act.
The case was brought in 2014 by Sarah Behnke, a former head actuary for Medicare Part D at Aetna.
Behnke accused CVS Caremark of having since 2010 caused health insurers, such as Aetna, to submit inflated claims to the Centers for Medicare and Medicaid Services (CMS), while pharmacies such as Rite Aid and Walgreens (WBA.O), opens new tab were paid less.
CVS bought Aetna in 2018.
Despite ruling for CVS Caremark on some claims, Goldberg concluded in a 105-page decision that the unit knew it was managing drug prices in a manner that boosted margins, and therefore profit.
"Although it is true that Aetna had the ultimate responsibility to submit the claims, I disagree that this responsibility absolves Caremark of culpability," Goldberg wrote.
CVS, based in Woonsocket, Rhode Island, said on Thursday it was disappointed in the rulings against CVS Caremark.
The False Claims Act lets whistleblowers sue on behalf of the government and share in recoveries, typically 15% to 30%.
Though not directly involved in Behnke's case, the federal government said in an October 2023 court filing it had a strong interest in ensuring that Medicare Part D did not pay inflated drug prices, and information reported by plan sponsors and pharmacy benefit managers to CMS reflects the true costs.
The case is US ex rel Behnke v CVS Caremark Corp et al, U.S. District Court, Eastern District of Pennsylvania, No. 14-00824.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Daily Mail
36 minutes ago
- Daily Mail
Top 10 highest paid Aussie jobs
Surgeon - $472,475 Anaesthetist - $447,193 Financial dealer - $355,233 Internal medicine specialist - $342,457 Psychiatrist - $286,146 Other medical practicioners - $259,802 Mining engineer - $206,423 Judicial and legal professionals - $206,408 CEOs and managing directors - $194,987 Financial investment advisor or manager - $191,986
Daily Mail
an hour ago
- Daily Mail
One of America's most iconic beach towns welcomes 1,100 new homes
Affordable housing units are set to break ground close to one of America's most iconic beaches. New York City officials are touting a new housing project just blocks away from Coney Island's boardwalk entrances. The neighborhood, which hangs on the southern tip of Brooklyn, offers a dose of chaos and nostalgia. A scent of fried dough hangs in the air, wooden roller coasters rattle overhead, and sunburned crowds shuffle between jam-packed beaches and hot dog stands. But not everyone is excited about the development. 'People say, "Don't get a heart attack on Fourth of July because it'll take two hours for ambulance to come to your house,"' Angela Kravtchenko, a vice chair of the local land use committee, told Gothamist. Nevertheless, city officials are touting the upcoming construction site as a win for affordability in a city battling a housing price crisis. The development will include 1,100 units of housing, including 720 affordable apartments. In one building, the average price for a one-bedroom will be around $1,800 a month, a steep discount compared to the rest of Brooklyn. In July, new renters in the borough signed leases that pushed the median rent over $2,800 a month for a 545-square-foot apartment. Nearby Coney Island homes are even pricier, with average monthly rent hovering above $3,200. Coney Island's newest housing is part of Mayor Eric Adams' sweeping plan to rewire New York's outdated zoning laws called 'City of Yes.' The city's top politician has been sifting through bureaucratic red tape to build housing, open small businesses, and install green tech like solar panels. For years, housing advocates have warned that demand keeps climbing while new apartment construction lags behind. The Adams administration says it's answering that call — with what it touts as two straight years of record-breaking homebuilding. Still, not everyone's convinced. The boardwalk is another popular tourist destination - nearby residents worry that increasing population density and tourism could be a toxic mix Drivers worry that the new development will clog streets in a neighborhood already buckling under traffic. It's the kind of issue the city has tried to tackle with tolling initiatives — most famously, congestion pricing in lower Manhattan. That plan slaps a $9 toll on cars entering below Central Park during peak hours. Officials say it's raising funds for public transit, reducing pollution, and clearing a path for emergency vehicles. But the system doesn't extend to Brooklyn. Also, environmental activists are worried that the area is increasingly at risk for sea-level rise. Hofstra University conducted a land survey that found most of Coney Island is expected to flood more frequently in the coming decade. Despite the backlash, the Mayor's office is charging ahead with the Coney Island project. Housing projects like this one are expected to feature prominently in Adams' re-election pitch. In the meantime, hot dog–loving future residents might want to prep their stomachs. They could soon be living steps away from Nathan's — and might compete in the chain's famous hot dog eating contest.
Daily Mail
an hour ago
- Daily Mail
Ominous sign house prices are poised to crash as stunning number of homeowners underwater
A massive amount of US home sellers are at risk of selling at a loss in the current housing market. One in six of today's US home sellers are likely to sell their property for less than they originally paid — up sharply from just 4.4 percent a year ago, reports Redfin. While the risk of selling at a loss varies widely by location, the national increase marks a significant shift from last year's market conditions. In San Francisco, for instance, nearly 20 percent of sellers are at risk of losing money, but virtually no one who sells in Providence, RI, will see a loss. The risk also depends heavily on the type of home. Condos are much more likely to be at risk of selling at a loss than standalone homes or townhouses. Redfin's data shows that nearly one in four condos are at risk of selling below their purchase price—and that number climbs to nearly 30 percent for condos bought after the pandemic boom. 'We are seeing the biggest price drops in the condo market,' said Redfin agent Andy Potarf. 'I had a seller who bought a condo for $570,000 in 2021 and it just sold for $525,000 last week. Sellers who have to sell are willing to take a bigger hit to get the deal done.' Potarf added that condo sellers are in a particularly tough position because many face restrictions—from HOAs or local authorities—on how they can lease their properties. 'A lot of condo sellers have a choice to make: stay put, or take a loss,' he said. For sellers who bought single-family homes after the pandemic, 16.4 percent of sellers are at risk of selling at a loss in today's market. Post-pandemic buyers paid high prices due to intense competition and record-low mortgage rates that created a buying frenzy. Bidding wars were common, and many homes sold for well above list price. 'Current sellers who bought their home after mid-2022 may have overextended themselves, thinking that prices were going to keep rising at similar rates,' said Redfin economist Asad Khan. ' 'Prices have kept ticking up since then, but at a slower pace—and now prices have started to fall in some parts of the country, especially in the Sun Belt. 'That means sellers are in a position where they may need to choose between accepting a lower price, or taking the home off the market.' Those who bought during the pandemic will see 9 percent of sellers take a loss. For those who bought homes before the pandemic, only 1.8 percent will take a loss. The Redfin analysis looked at active listings on the MLS in May, and predicted how much a home is likely to sell for based on the sale-to-list price ratio of the metro area where it is located. For example, if a listed home is priced at $500,000 in a metro where the sale-to-list price ratio is 95 percent (where homes sell on average for 5 percent under the original list price), they predict that the home will sell for $475,000. Next, Redfin compared the expected sale price to what the seller originally paid for the home. The report found that many would-be sellers facing a financial loss will simply wait until they find a buyer willing to pay the asking price, while others may take their home off the market and continue to live in it or rent it out. In the early 2010s, following the global financial crisis, roughly half of for-sale homes were at risk of selling at a loss. Even prior to the pandemic, in early 2020, around 10 percent of for-sale homes were at risk of selling for less than their purchase price. Redfin senior economist Asad Khan said the sellers facing a loss today is good news for buyers. 'We are seeing more opportunities for buyers to pay a little less than they would have just a year or two ago,' he said. 'That's because sellers with significant equity in their homes—and therefore at no risk of selling at a loss—are more willing to be flexible on price. 'That's a meaningful shift for anyone who's been watching and waiting for prices to come down, especially first-time homebuyers.' Khan said that the longer someone has owned their home, the more likely they are to come out ahead. 'But that's little comfort for those who bought more recently and may be facing a loss,' said Khan. 'Not every homeowner is listing because they want to—some are listing because they have to. 'In those cases, it's important to list at a realistic price for the market and be prepared to adjust depending on buyer interest.' Redfin agents in some parts of the country report that some sellers who don't need to move immediately have already opted to de-list their home. 'A lot of sellers are taking their home off the market rather than reducing their price, with the idea of listing it again next year,' said Aditi Jain, a Redfin agent in Boston. 'They're not motivated by making money the way they would have been two or three years ago because there's not as much money to make. 'Another trend with sellers is they're accepting offers instantly. If they get one solid offer, they're signing the contract, cancelling other tours and open houses, and trying to close the deal as soon as possible.' Florida in particular has homes for sale at rock bottom prices. With a surplus of listings flooding the market, soaring HOA fees and sky-high insurance rates, owners just can't unload their homes so they are slashing prices. One two-bedroom, two-bathroom condo in the Hunters Run community of Boynton Beach, complete with a pool and a gym, was purchased in 2002 for $91,000. It's now going for just $1,000. The HOA fees are a whopping $1,503, but for a $1,000 home, the buyer still gets a deal. Plus, with no mortgage, a buyer would eliminate that bill, too. Residency in the neighborhood comes with an amenities-filled community, including three championship 18-hole golf courses, tennis and pickle ball courts, six dining venues, multiple pools, a fitness center, a spa, a salon and monthly entertainment. Another condo in the area that sold for $29,000 in 2015 is now listed at $9,500 - that's after the original $19,000 price tag was slashed in half.
